Children's Tumor Center: consolidated treatment under one roof

Interview with Professor Andreas Kulozik, Medical Director for the Department of Pediatric Oncology, Hematology, and Immunology, Heidelberg University Hospital, Germany

01/02/2017

Treatments for children need to be different from treatment for adults – this also applies in oncology. Having said that, children do not just need new and different treatment concepts that still necessitate research. They also require the support from their families, who need to be nearby during treatment. Accommodation, research, and application – a children's tumor center is able to offer all three.

In this interview with MEDICA-tradefair.com, Prof. Andreas Kulozik talks about these and other advantages of a children’s tumor center, discusses customized and personalized treatment concepts and explains why pediatric oncology is entirely different compared to adult oncology.

Prof. Kulozik, the Heidelberg University Hospital and the German Cancer Research Center recently founded the "Hopp Children’s Tumor Center at NCT Heidelberg", KiTZ in short. What is the idea behind it?

Prof. Andreas Kulozik: The team that includes Prof. Olaf Witt, Prof. Stefan Pfister and myself has pondered the idea of combining the different pediatric oncology processes in one location for quite some time. However, we were only recently able to obtain the support of the University Hospital within the context of contract negotiations, to where this idea is just now gaining momentum. A central component is also the new building for which we are currently still securing funding. A dedicated building will finally allow us to consolidate all of the pediatric oncology stakeholders, who are currently still working at different campus locations, under one roof.

What specific advantages does this Center offer physicians and patients?

Kulozik: All stakeholders – scientists, medical professionals and nursing staff - will benefit from streamlined and shorter processes. In our opinion, this creates the foundation for translating new findings and insights from science into medicine much faster. For example, it will be much easier for our researchers to get input to scientific questions when physicians have a specific medical need. As is often the case in life, we are able to make faster progress if we talk to each other and do not work alone. The advantage for patients is that scientific innovation can subsequently also be implemented much faster in studies.

One of your goals is to better adapt treatment concepts to patients. How does pediatric oncology already apply customized procedures today?

Kulozik: That depends on how you define a "customized treatment concept". On the one hand, it can be seen as a risk-adapted treatment: higher-risk patients receive more intensive therapy than patients with a lower risk. These types of strategies have already been applied for many years for a variety of diseases, for instance, to treat various types of leukemia. There are highly sensitive techniques to determine the kinetics of leukocyte disappearance from the blood: we adapt the therapy depending on whether they disappear at a slower or faster rate during treatment. Overall, this strategy leads to better treatment results.

On the other hand, we are now increasingly able to identify molecular and genetic profiles of tumors and detect which cell signaling pathways are altered in the tumors and how we can systematically affect them with drugs. These are growth-promoting processes that are no longer properly controlled in cancer cells for instance. There are a variety of options to slow these processes down with the help of specific drugs. Today, this is called individualized or personalized medicine. Our hope is to develop an improved, targeted treatment with hopefully fewer side effects through subtle genetic analysis of different types of leukemia and tumors.

Are there any specific difficulties in the treatment of cancer in children, or can you use the same treatment methods you use in adults?

Kulozik: There is no easy answer to this important and technically simple question. Children tolerate certain medications much better than adults do. Based on body weight, we are able to give children a much higher dose for a range of cytostatic drugs – these are drugs that are also used in chemotherapy - than we can with adults. Having said that, there are also drugs that can be administered much easier in older patients, for example, drugs that affect fertility and whose side effects are thus less relevant in older people who no longer need family planning versus adolescents, who still do.

Generally speaking, children are actually able to tolerate lots of therapy. Needless to say, very small children, newborns or babies are the exceptions. What's more, there are entirely different types of cancers occurring in childhood than there are in adult age. There are virtually no occurrences of lung or colon cancer in children, those being the common types of cancer in adults. Conversely, we rarely see adults affected by the most common types of cancer in children.

Aside from biology, we obviously also need to address the environment and the overall family situation. If a child is seriously ill, it is a very different situation for a family compared to when an older adult falls ill. This essentially makes pediatric oncology entirely different from adult oncology.

Finally, I would like to get back to the planned new building: in your eyes, what should an ideal children's tumor center look like?

Kulozik: We plan to have facilities at the Center where we are able to accommodate the patients and their families. With certain breaks in between, families often spend several months with us, making their accommodation a very important issue.

We also want to have rooms where we can test our new treatment approaches. This always requires a specific infrastructure since monitoring must be far more elaborate in this case compared to standard therapies. That is the translation of preclinical research into clinical trials. It also poses a significant challenge to patient safety.

Finally, we need the foundations for preclinical research in the same building, that being laboratories for physicians who are both involved in clinical and scientific operations. All in all, the building should fulfill three requirements needed for successful pediatric oncology: excellent preclinical research, good translational research and a great level of patient care.